Planning for Universal Coverage

Last month, the Oregon Health Fund Board began meeting to create a plan for universal health care in Oregon that will be presented to the State Legislature in 2009. The Associated Press reports on some of their early ideas:

Discussions are still preliminary. But key centerpieces of a likely plan are taking shape, including a major expansion of the existing Oregon Health Plan, and a "health exchange," allowing self-employed individuals and small businesses a forum to purchase health coverage.

The idea is to pool their collective purchasing power, making it easier to track down a cost-effective insurance plan. The menu of choices would be negotiated over and maintained by an independent board. Individuals who change jobs would be able to maintain their health care.

The proposal is less dramatic than doing away with employer provided health care, a key part of a proposal that's being pushed by U.S. Sen. Ron Wyden, D-Ore., and has attracted bipartisan support in the Senate. But the lack of such sweeping change is intended to help sell the program to the wider public, about 80 percent of whom have health care coverage, mainly through their employer.

Like Massachusetts, Oregon's new plan could also require the state's residents to have health insurance, much the same way that all drivers are required to purchase auto insurance. Those who choose not to purchase health care could be penalized, perhaps by forfeiting their tax rebate "kicker" checks.

Besides expanded access to the Oregon Health Plan for the state's poorest families, people who make up to $62,000 per year in a family of four could be eligible to get reduced premiums for their care if they join the state program.

The Health Fund Board has also begun discussing possible funding sources for universal coverage:

The question, of course, is how to pay for it all.

The Oregon Health Policy Commission has estimated that putting such a system in place would cost $550 million a year, a significant chunk of the $15.8 billion that's projected to be in the state budget for the 2009-2011 fiscal cycle.

One possibility is a payroll tax, though whether employers and employees would both pay the tax is an open question. It's also unclear whether employers that provide their own private health insurance plans would be allowed to opt out, or pay a discounted rate.

The health fund board could also eye a series of more unorthodox revenue streams, like a "medical luxury tax", charged to those who undergo expensive cosmetic surgery procedures, or a "health transaction tax", similar to one in place in Minnesota, that would impose a surcharge on visits to doctors or hospitals.

But given the historical distaste of Oregon voters for any sort of new taxes, or expanded government programs, legislators will likely punt a decision on any funding mechanism to voters.

Read the rest. What do you think of the board's preliminary ideas?


  • (Show?)

    As part of the team that passed the Bates/Westlund bill, the Healthy Oregon Act last session, let me share a bit about what we learned. First, we need to stop calling it universal coverage. The term that polls best according to Celinda Lake is "Guaranteed affordable choice".

    96% of voters have health care so when we lead with access arguments, we lose them. Voters support everyone having access, as long as it doesn't take away from what they already have. (This is why the Archimedes movement had problems, seniors perceived it as taking away from them.)

    Also, people want a choice of plans, not just to be dumped into a state plan. Public/private partnerships are very popular.

    Oregon is the only state pushing reform that got the support of business organizations. We talked about how small employers don't have the same leverage as large corporations when it comes to purchasing healthcare. The Oregon Health Fund, established by the bill will allow businesses to pool their health care dollars to leverage buying power, share risk and lower costs. If a business or union is already happy with their coverage, they don't have to join.

    Number one polling point to pooling- people with pre-existing conditions can be covered. Voters love this and are way more likely to support reform. Add portability so you can keep your insurance if you change or lose your job and all of a sudden, reform starts to become reality.

    Guaranteed affordable choice outpolls single-payer every time. Heatlh care reform will be an incremental process and I applaud the members of the Halts Fund Board and their subcommittees for be willing to serve.

  • andy (unverified)

    Universal health care is a great idea as long as I don't have to pay for it. But if I have to pay for it then I have a bunch of questions such as what exactly does universal mean, and who decides what is covered, and stuff like that. If illegal immigrants are covered then I'm not so interested. If 15 year old girls can get free breast implants then I'm not interested in paying, if obese people get free medical care even though they refuse to take even moderate steps to shape up then I'm not so interested. If smokers get free lung transplants then count me out. Etc.

  • JHL (unverified)

    Andy, I got news for you: You ARE paying for universal health care! It's called the Emergency Room and it provides health care at ridiculously expensive rates that you end up paying for. If you have health care already, the cost is added to your premiums. If you pay taxes, you pay because it's added to all the health plans that the state buys. Count you out? You're already in it, buddy!

    Andy, the "universal" in "universal health care" (sorry... "Guaranteed affordable choice") refers to who's covered, not what services are covered. Have you seriously ever heard of cosmetic surgery being covered?

  • LT (unverified)

    What about a person who doesn't have employer based health care coverage? Should they feel better because most people have health care coverage? What should they cut out of their budget to pay for health care insurance? No matter how many voters have insurance, will it cover what treatment they need?

    John Stewart had a line awhile back, responding to a Bush quote on this subject, "I want people to be closer to their doctors. Stewart, "OH! I GET IT! He thinks the uninsured have doctors!"

    Like the Canadian who said "love to visit US but wouldn't want to get sick here", it is time to have some serious discussions about this, as Bates and Westlund are doing.

    As the old saying goes, when one side talks statistics and the other side tells a story, the story side wins. With all due respect to Stacey and Celinda, it is important to tell a story and not just talks about what polls well. Any cause needs to attract the attention of bright young people and others who might not follow politics closely.

    It is time to examine the whole system. That includes the role of insurance companies in all this.

  • BHamm (unverified)

    As McCally as it sounds, is there a provision to handle the influx of chronically uninsured people to the state, who figure, "hey, I might not always have steady work, but if I move to Oregon, I can always have health care!"

    We already have people moving here from all over the country because of cycling, the outdoors, sustainability, trendiness, etc. The secret's out. How do we deal with yet another huge draw for people to move here?

  • Bill Bodden (unverified)

    It is time to examine the whole system. That includes the role of insurance companies in all this.

    And we also need to deflate all prevalent myths as a comment above makes abundantly clear.

  • Realism 101 (unverified)

    Does the Oregon Health Fund Board really stand a chance of getting of the ground and coming up with a proposal that works for Oregon in the short time frame they have? Considering the the high vote count SB329 had when it passed out of the legislature, there seems to be a rather lager silence surrounding it now.

    Why are working on a mandated insurance plan? Why pay for something that doesn't serve our "real" needs. Do we even know what we're paying for? Where's the transparency in this system for consumers (individuals and also the state)?

    I'm now jumping off subject but this plan is far from universal or whatever word you choose to use. Let's just be real about it when we talk about what we can do in Oregon with this board and moving forward. I just feel the expectations were set way to high for this yet-to-be program.

  • Israel Bayer (unverified)

    "We already have people moving here from all over the country because of cycling, the outdoors, sustainability, trendiness, etc. The secret's out. How do we deal with yet another huge draw for people to move here?"

    This is overblown. Do we honestly think someone who is piss poor in any number of places around the country is going to pick up and move to Oregon because they might receive better health care?

    Some say the same about homeless services in Portland. The soup lines and shelters are so great in Portland that homeless people flock to the Rose City, all just to stand in line and be homeless in the rain. Amazing.

    The secret is out. And if poor people want to move to Oregon, it's going to be for the same reasons anyone would move to Oregon - it's a great place to live.

    "96% of voters have health care so when we lead with access arguments, we lose them. Voters support everyone having access, as long as it doesn't take away from what they already have." Sister, this is why poor and young people in America don't give a shit about politics! If you tell them not only are they fucked, but they don't even matter in the context of developing policy and strategy, why should they care?

  • Bill Bodden (unverified)

    "We already have people moving here from all over the country because of cycling, the outdoors, sustainability, trendiness, etc. The secret's out. How do we deal with yet another huge draw for people to move here?"

    And there are also lots of Oregonians leaving Oregon for other states for other reasons.

    Many people said that if assisted suicide became legal there would be a flood of sick people coming to Oregon to take advantage of it. It didn't happen. Most projections about what people would do should be regarded with a good measure of skepticism.

  • Chuck Butcher (unverified)

    So, taxpayers will be mandated to provide insurance company profits. You propose to look at my income and tell me what I can afford to do under a mandate? Due to existing conditions, which have already bankrupted me once, my wife is realistically uninsurable, so which company has to take her and pass their profit loss on to whom? This is essentially the same program we have now with healthy people with mid-insurance coverage paying for those who are screwed, already.

    Not for profit single payer is what changes the game, but fear of Ins Co clout scares everybody. I already have mandated insurances all over me and some are real expensive to pay for other people in other places screw ups.

  • LT (unverified)

    Just came across an interesting mention in a Craigslist job posting:



    Makes me wonder about the statistic that 96% of voters have health care. How was that arrived at, a poll or matching the voter rolls to the insurance rolls, or what??

    And about Archimedes and "seniors", does every Oregonian over 70 know about the plan and react that way? Or is that a poll result?

    I'm guessing that there are more people either uninsured, with very limited insurance, or in situations like the above where they start a new job and don't get health insurance right away than the 96% statistic takes into account.

  • Michael Wilson (unverified)

    Someone may want to take a look at some of the problems behind the high cost of healthcare.

    Recently I came across a study that noted that in Europe 75% of births are attended to by a midwife. In the U.S. it is about 10%. And in Europe the midwives have a higher survival rate and lower costs than doctors. So how many births in Oregon are handled by midwives and can the numbers be improved? If I recall there is a case in the courts from Eugene about a couple of midwives that were denied an opportunity to work at the local hospital because of the objections of the doctors.

    Michael Wilson

  • Tom Civiletti (unverified)

    Stacy Dycus wrote

    "Guaranteed affordable choice outpolls single-payer every time."

    This is not surprising given the relentless propagandizing in the corporate media against single payer, socialized medicine, etc. The simple truth is that nothing but single payer will provide decent healthcare for all Americans without driving us broke. That is:

    Nothing but single payer will provide decent healthcare for all Americans without driving us broke.

    Dennis Kucinich is the only presidential candidate with the cujones to make this simple truth part of his platform. It's time to stand up to the insurance companies. It's time to stand up to the drug companies. It's time to stand up to the for-profit hospitals. Every time an American dies for lack of decent healthcare, we all are complicit. The wealthiest country on the planet has the health statistics of a third world nation. And we are paying through the nose for this lousy system.

  • Thomas Ware (unverified)

    Funny how these plans bear a striking resemblance to changes that were proposed in 1974 - by the late President Richard M. Nixon.

  • Bill Bodden (unverified)

    The World Health Organization has a series of annual reports on its web site. The 2000 report has tables comparing quality of care in all countries. Despite being touted as having a great health system, Cuba only made 38th on the list; whereas, the United States came out ahead at 37th. Maybe, if it hadn't been under such inhumane embargoes, Cuba would have been higher up the table.

  • Lewis (unverified)

    Are there any other states to have universal health care already? I think it's an excellent opportunity to prove a horribly valuable point not only to other states, but to our federal government, of what is possible..and how citizens can be taken care of.

  • JHL (unverified)

    Fact: Dennis Kucinich will not be the next president. (Sorry, that's as good as fact.)

    Fact: "Guaranteed affordable choice" has the momentum and support to result in actual universal coverage in the next few years.

    Fact: Regardless of the cause of the movement's woes, single payer lacks both the momentum and the support to be implemented anytime soon.

    So... While you single-payer guys dream your dreamy dreams of utopian fantasies, mind if the rest of us grab some of that "guaranteed affordable choice" stuff in the meantime?

  • LT (unverified)

    "guaranteed affordable choice" may be a good soundbite. But in a townhall or other group of voters, will a candidate saying "my health care plan involves "guaranteed affordable choice" really impress the ordinary voters? Regardless of the 96% figure, does anyone know for a fact that in a town hall of 50 people that 48 of those people will have health care coverage?

  • (Show?)

    does anyone know for a fact that in a town hall of 50 people that 48 of those people will have health care coverage?

    96% of voters LT, not people. I'm a member of the Herndon Alliance working on American solutions to health care and I got this stat from Celinda Lake at a presentation I saw in D.C. a few weeks ago. It affirmed Oregon is on the right track in terms of what is possible in the near future. It's online. Candidates and legislators should watch.

  • humblerodent (unverified)

    Kitzhaber's latest blog:

    Kitzhaber Blog


  • LT (unverified)

    Stacey, I am a long time voter. I don't have health insurance. Regardless of what statistics you may have read, my question is this: If I were in a room of 100 people who voted in 2006, are you that sure of your statistics to be sure that in the room of 100 people, 96 would have health insurance, and only 3 other people and I would be without it?

    Or could it possibly be that a room filled with 100 Oregonians who voted in the last election might be different than the statistics?

    A friend and I recently had a discussion in which he said of a certain activist that some people get so wrapped up in analyzing data they forget there are actual people involved who don't always conform to the data (or something like that).

    The original post here says, "But the lack of such sweeping change is intended to help sell the program to the wider public, about 80 percent of whom have health care coverage, mainly through their employer."

    My question is about statistics vs. real life. If any candidate goes into a room of 100 people who voted in the last election, they would be wiser to ask for a show of hands (or some other measurement) or to say "According to statistics, somewhere between 80 and 96 people in this room have health insurance--I'd like to know if that is true with this group" than to claim the statistics are perfect so of course real life conforms to the statistics and the candidate knows that at least 80 people in the room have health insurance. What about people who work part time--how many of them have health insurance?

    One of the big "under the radar" discussions going on among people who probably vote the same way most Blue Oregonians vote is whether analytical politics (polls and other statistics, consultants, etc.) work on their own or whether they need a people-oriented component to succeed. I believe the latter, as do some of my friends.

    And for that matter, one Republican friend who is running for office agrees about the importance of relating politics to the real world, esp. on the subject of health care.

  • Robert Harris (unverified)

    My first reaction is to ask....are employers going to be pumping another $550,000,000 per year into the insurance company's pockets? Into a system thats already twice as expensive as most other industrial countries while covering far fewer people?

    I provide health insurance to my employees, so I already help pay for the uninsured in Oregon. Employers who don't provide coverage to employees are benefiting from my willingness to subsidize the health of their workforce.

    I'm a pretty progessive, family friendly employer, but I've got to be friendly with my own family as well, so I'll withhold my support for any program like this absent a promise right up front that Employers who provide health insurance now won't be paying any more in taxes, unless there is a corresponding reduction in premiums.

    A "to be determined later" promise on how much employers will pay will absolutely, positively, not fly with me.

    If you want to mandate a reduction in rates and increase my taxes proportionally, thats fine. But the system doesn't need more money going to insurance companies, hospitals doctors or drug companies. It just needs a reallocation of the money we already spend.

    And if the best we can come up with is to pay EVEN MORE for our health care system then I say let the system implode. Then we can start over with a more sensible structure.

  • Lonnie G. (unverified)

    I can't believe the word "perceived" was used to describe the "so called" problems with the Archimedes bill.

    The "perception" of taking away from Seniors was AARP's schtick, to stop debate on a bill that would have cut into their financial bottom-line.

    Interesting to note that Westlund's "team" was taking their marching orders on their bill, The Healthy Oregon Act, from a thinly disguised special interest group that had something to lose.

    AARP is "great" when an issue doesn't "cost" or require them to make a sacrifice, whether real or "perceived." As in, for example: "how many brownie points is it going to cost us in public perception if we endorse M50??" When the going got tough to cover kids this last special election, where was AARP? Nowhere. Silent.

    But, I digress. I find it ironic that instead of seeing the two bills as complimentary, AARP/Insurance Companies messaged the Archimedes Bill and Westlund's bill as being in "competition" with each other.

    Quick example: In the 2005 legislature, there were two bills dealing with early childhood education. One with Headstart funding, the second, full day kindergarden. Only Headstart got funded, kindergarden, didn't get funded that go around. The argument, (albeit a false one) was that the two bills "competed" with each other. This last session, something about funding for full day kindergarden did emerge. So much for the competition argument. Legislators on both sides of the aisle supported both bills both sessions.

    Once the smoke clears room, it'll be obvious about the choices that will have to be made about the Healthy Oregon Act--and that is that the principles behind "We Can Do Better," will have to go hand in hand with HOA if long term viable solutions are to occur. For those that may be interested, go check this out.

  • Tom Civiletti (unverified)


    Political momentum for a system that cannot successfully function is worthless. It's easy to generate political momentum when powerful interests are not challenged. Unfortunately, we cannot provide decent healthcare for all Americans unless some powerful interests are confronted and defeated. Unless "Guaranteed affordable choice" is a euphemism for single-payer, it will not control the outrageous inflation in healthcare costs the US has experienced and will continue to experience as long as insurance companies, drug manufacturers, and for-profit providers have their way.

    And why is a system that works quite well in several less wealthy nations Utopian? That sounds like damnable political spin to me.

    If Dennis Kucinich does not become the next president, it is because people like you do not support him.

  • (Show?)

    absent a promise right up front that Employers who provide health insurance now won't be paying any more in taxes, unless there is a corresponding reduction in premiums.

    Good point Robert. One idea that has been discussed is that if there were an across-the-board payroll tax, employers who are providing adequate coverage could be reimbursed by the state.

  • Lonnie G. (unverified)

    Yeah, but Stacey, how well does that point Robert makes poll??

  • JTT (unverified)

    You know what peeves me? It's when people who are supposedly working for the same thing try and cannibalize each other. Anyone with half a brain knows that single payer is a non-starter politically (for the time being). Frankly I'm open to the idea after seeing some numbers out of New Mexico that a single-payer system there would result in SIGNIFICANT cost savings. But then again, I like competition and the good ol' free market and the idea of health plans having to compete for business on transparent quality, outcomes, and cost. I think it's a valid argument, and one that we should have. The point is Senators Bates and Westlund were able to develop a plan that yielded tremendous support and momentum in the last session. We're seriously talking about every Oregonian being able to go to the doctor and afford it and not having to worry about if the next serious illness will bankrupt the family. Small businesses might actually be able to afford to purchase health insurance for their employees. And could you imagine not choosing a job based on whether they provided health insurance or not?

    Because you might not get your preferred style of guaranteed affordable choice, please don't poo-poo progress for the rest of us. And yes of course they were competing bills-they both essentially did the same things and we live in the real world where there are limited resources (i.e. people, time, and money), so the stronger proposal was passed. PS Lonnie-either I'm misreading your comments, or you're being an ass. How is that helpful? And Tom - you may want to do a little more research, but (internationally speaking) universal does not necessarily equal single payer. And who's to say that what works in France, Germany, Sweden, Japan, etc...will work in Oregon. As J.K. would say, I think "we can do better".

    I for one an excited to follow what the Health Fund Board is doing and will be excited to see Oregon move toward guaranteed affordable choice. ;-)

  • Chris Lowe (unverified)

    The AP report is describing details that I think must come from a report that the Oregon Health Policy Commission made last Spring, which I think influenced the process producing SB 329 pretty strongly. I'll try to get a link later.

    Kitzhaber's proposals, which he openly states are as much about forcing certain issues at the national level about the fragmentation of the healthcare system as moving forward in Oregon, are highly problematic concerning Medicare, because they involve pooling current public healthcare monies but don't address the fact that they are raised in dramatically different ways.

    andy has given us an interesting example of the kind of "make sh*t up" propaganda any reform effort will face. On one point, virtually all such plans explicitly exclude cosmetic surgery except for remediation of effects of breast cancer surgery.

    Massachusetts has is a few years into implementing a version of a personal insurance mandate. The idea is based on the German system, which origated with Otto von Bismarck in the 1880s and provided a partial model for U.S. Social Security.

    Arnold Schwarznegger is pushing a version of a personal mandate system, after vetoing a single-payer plan passed by the state leg. there.

  • Maribeth (unverified)

    Here's the real issue-if Oregonians really want to change the health care system, our opportunity is now. Tom- indeed we need to have strong accountability in the insurance industry. If they can manage to reduce administrative costs, (as they do in other countries ) and as is done under Medicare, then we are holding them to account to the payers-you and me-as taxpayers and as purchasers of health care.

    The "guaranteed choice" phrase is really about the benefit package, not the system itself. Other countries manage to "insure" all people, true, but the biggest difference (yes there are financing differences) but the biggest is the focus on PREVENTION and primary care. Discussions underway at the Board and on the committees is to refocus in this area, develop the fair method of financing, change the market so we (yeah, you and me again) get the best bang for our buck. The committees are looking at spending as well. If it's true that "there is enough money in the system" we need to include the profit in that figure and redistribute the money to provide a "guaranteed affordable choice" of benefits to our people. There are tough issues to decide, and yes, industry to deal with. But our opportunity is great because EVERYBODY, industry included, knows that this system is not working and we all need to change.

    Also- to Robert- that is the exact issue. If you provide health benefits to your employees (as I do) and we spend on average 12K a year for that; the combination of the new funding and premium must be lower if we are to succeed. But, the other pieces have to happen; cost containment, redistribution of the current dollars (see if we need new dollars) and primary care renewal, as examples.

  • Maribeth (unverified)

    Addendum- 12K per year per employee for family coverage

  • Tom Civiletti (unverified)


    We are looking for the same outcomes. Perhaps I am more jaded than you. When you write:

    "But our opportunity is great because EVERYBODY, industry included, knows that this system is not working and we all need to change."

    I notice that the current system IS working well for the for-profit segment of the healthcare system. Their bottom line is doing just fine. Their willingness to take part in discussion on system reform extends to the point that reform would guarantee their continued profits. I do not believe that effective fundamental reform can succeed while preserving those profits, or the pressures put on healthcare decision-making by the desire to maximize those profits.

    I recognize your desire for quick change. Real people are suffering mightily right now. But I believe that incremental change within the current system will continue to see increased healthcare delivery swallowed by increasing healthcare costs. Wasting our time on reforms that will not work means less decent healthcare for people in the long run. Given the rate of healthcare cost inflation, the longterm is close at hand.

  • Lonnie G. (unverified)

    JTT & Stacey: I'm just curious who paid for the poll that dictated the outcome of a piece of public policy.

    I don't think this is about "cannibalizing each other." Rather, it's about augmenting policy pieces together so that the sum of the parts could have been greater than the two individual bills.

    I certainly think the OBA has it's good points, to be sure. My intention is not, "to be an ass." Rather it's to point out the glaring contradictions that it's "our way, or the highway" without fully debating the merits of the Archimedes health care vision.

    It's such a shame that the two bills didn't merge as Bates, Westlund & Kitzhaber originally planned on. And when I say "merged" I mean the Medicare piece. As it is now, even Mitch Greenlick is on record as referring to the Healthy Oregon Act as "Massachusetts Lite." And, the Massachusetts Health Plan already is running into problems.

    I like it when government works so that Democrats can point to successes when government/public policies are enacted. Quick change without fully looking at all of the consequences, both good and bad, can be detrimental to our long term goals.

    There is value in incremental change, as in M50 would have done. And HOA is about incremental change, and for the better, to be sure. But, it would have been MORE incremental change, and gotten the "health care issue" further down the alley had the Archimedes principles been debated in the session instead of squelched by AARP/Insurance. I would have like to have seen the Archimedes principles along with the HOA discussed together.

    Granted, many aspects of the two bills were similar, but with one glaring difference that made ALL the difference: Designing a health plan that included all public (including Medicare) dollars as the Archimedes movement discusses.

    Kitzhaber's site, gives people a safe forum to discuss their ideas on what a health care system could look like if we were given the opportunity to explore new ideas. Exploration is a good thing as are new ideas.

    An opportunity to discuss ideas without being shot down with the proverbial "our poll says... so therefore you don't get a seat at the table." is counterproductive to a healthy public dialogue.

  • Chris Lowe (unverified)

    Dennis Kucinich unfortunately proves to be an absolutely atrocious advocate for H.R. 676 & the broader idea of single payer. I will try to dig up a link to a transcript of his session in a series Kaiser Foundation & another foundation is sponsoring, interviewing as many of the presidential candidates as will participate on their healthcare proposals. He appears to be almost completely ignorant about concrete issues.

    Also there really isn't anywhere else that has a system like what's envisioned in H.R. 676. Canada has not structured its system so that doctors have to convert their practices to non-profits in order to be compensated. Less sure about hospitals. I'm not sure the for profit/not for profit distinction actually is relevant to most European systems, with the possible exception of the German Sickness Funds & what looks like a similar system in the Netherlands.

    Lonnie G., I have been active in Archimedes on & off, but looking more deeply into various proposals I now think that the Archimedes/WCDB approach to Medicare is wrong morally as well as politically. The idea of just folding "medicare dollars" into a common pool, which will then be redistributed to provide a more limited general benefit to all (i.e. elders net lose financial support for their care) is wrong. Medicare is based on a highly regressive payroll tax that underwrites the system politically, because they feel they will be "getting back" in retirement because they "put in" while working. Changing that intergenerational social contract is wrong.

    Also, your arguments confirm for me an implication I was beginning to see, which is that the Archimedes approach leads to generational war rhetoric that pits elders against children. I want my daughter to have good healthcare and my parents too. I refuse to choose between them and think we can defeat politically anyone who tries to force such a reactionary choice. You have an interesting point about AARP not standing up for kids, but is Archimedes really standing up for elders. We have to refuse this kind of divisiveness, but I increasingly think Archimedes is promoting it.

    Not all doctors get paid too much. Primary care doctors in Medicare have real problems making ends meet in their small businesses. Rural doctors don't get adequately compensated.

  • Tom Civiletti (unverified)

    My daughter is a rural primary care physician serving low income patients. I believe she is more concerned with people getting good health care than than with how wealthy she becomes.

  • Chris Lowe (unverified)

    Tom, I wasn't talking about anyone getting wealthy. Mainly I was talking about a real problem of costs in running medical offices, which in addition to the Medicare dimension, also is a place where the inefficiencies of the private insurance system manifest themselves.

    Your daughter's choice is wonderful and I have no doubt greatly appreciated. But I bet she could use more resources, given the general issues with rural health care, never mind care oriented to the least well off. I don't think it's fair to require people who do good work to be self-sacrificing saints compared to other folks. It may be particularly unfair to women, and particularly common for them. I know you know the long tradition about that as well as I do, maybe better, because my own daughter is still a kid & hasn't yet hit stuff she most likely will & maybe yours has.

    As far as doctor pay goes, one other thing we need to do is reform medical education. The debt burden becomes both a prod and a rationalization for numbers of docs to move away from their more idealistic motivations I think.


    Pretty much I support H.R. 676, at least as a position to bargain from if it got some more traction. But it does go beyond the Canadian system, both on national integration -- which is good, decline in federal funding is hurting the Canadian system -- and on moving to a non-profit based system. I'm still trying to think through the conversion to non-profit aspects.

    And I'm glad Kucinich is running on it & hope people do look at his webpage etc. I don't have a problem with his general position. But I was really disappointed that he wasn't more articulate about it in the forum. He flubbed some questions about funding the transition to non-profit status for docs & hospitals that really aren't so hard to answer in principle. I came away not really believing his claims to have been heavily involved in drafting the bill. The strength of his advocacy matters, especially because one of his major arguments was that he'd exercise leadership to persuade people. But no president is an island, and if he did get elected I suppose he could get better at it.

    On the other hand, you are right about his having the unique courage to stand up for it now, which does show him exercising that leadership at a more general level. I'm grateful for that. I imagine I'll vote for him but that it will mainly be symbolic by the time our primary rolls around.

  • lonnie G. (unverified)

    Chris: I respectfully disagree. The AM movement is about having a discussion on what a health care plan could look like with all the participants at the table. A HUGE chunk of those folks at the table ARE seniors as they are concerned about Medicare insolvency as much as people like myself. To my knowledge, AARP is the only senior group, (I may be wrong, but I don't think so, I'll eat crow if I am wrong) that isn't in some form participating in the discussions on Medicare.

    One part of the conversation around Archimedes principles is to pull together the younger set and seniors to come to consensus for a plan that can work for all of us.

    Politically, the time may not have been ripe for the principles of We Can Do Better to pass this last session. But the civil rights movement, for instance, wasn't won overnight either, nor, as I cited earlier, did funding for full-day kindergarden pass in the 2005 session, but funding for Headstart did.

    We do need to continue to have serious and constructive conversations about Health Care and about Medicare as it will be insolvent, (for different reasons than social security and I certainly don't agree with privatizing Social Security as has been advocated by some).

    I disagree that those conversations we should have are simply "war rhetoric." But rather are a good faith attempt to continue to move the debate on health care forward in a constructive manner where all sides can be heard. Medicare is an American Value that we can point to, and proudly point to, as helping to alleviate poverty among seniors in the United States and those with disabilities.

    The question as I see it is how do we make it even better, not JUST for our seniors, but for everyone? I just don't see how those values can be called "reactionary." Medicare came into being over 40 years ago; it needs an upgrade to reflect improvements in medical science, a larger aging population so people can have access to care that actually produces better health for all of us.

    But, I'll be the first to defend your right to your point of view for a debate on Medicare in an AM arena. You mentioned you've been active "on and off" again, it is my sincere hope that you participate in the discussions and put forth your concerns. The big thing to remember is that the AM forum is a safe one so all points of view can be heard and taken into consideration.

    This last session, AM citizens lobbied their legislators not just for We Can Do Better principles, but also in support of the HOA and the Healthy Kids bill. The conversations people had on HOA and Kids was sincere with our legislators.

    <h2>Be that as it may, I hope, as do most Archimedes members, that the Healthy Oregon Act IS successful. And citizen participation is going to crucial. We want the HOA to be the best it can be. I am also hoping that we can continue to have conversations about health care and not be accused of "war rhetoric" when people like you and I disagree on METHODOLOGY of getting everyone covered, as I am sure you and I share common ground that everyone should be covered.</h2>
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